Pre-Existing Condition Protections
Under the provisions of the Affordable Care Act (ACA), health insurance providers are prohibited from denying health insurance coverage, increasing insurance costs, or limiting insurance benefits based on an individual’s pre-existing health conditions — with the exception of grandfathered plans (i.e. health insurance plans created before March 23, 2010). Pre-existing conditions are health implications that existed prior to insurance coverage, including cancer, diabetes, asthma, mental disorders, etc.. Prior to the ACA, 30% of Americans under the age of 65 could be denied insurance due to pre-existing conditions and millions who were able to attain insurance encountered price discrimination.
A poll conducted in 2010, concluded that nearly 476,000 Utahns under the age of 65 have pre-existing health conditions and could previously be denied health insurances coverage. Currently, 200,000 Utahns purchase their health insurance through the Affordable Health Care marketplace to ensure coverage regardless of their health status. It is essential for the federal government to maintain the pre-existing condition stipulations of the Affordable Care Act to protect Utah citizens’ right to health insurance, as well as all Americans’.
The current efforts to repeal and replace the Affordable Care Act could cause numerous repercussions, including the possibility of losing pre-existing condition protection. 1 in 4 American men, women, and children could again be denied health insurance or charged astronomical premium prices. Due to the vast number of Americans who benefit from the provisions, it has received widespread support — even from many of those actively working to repeal the ACA.
Proposed ACA alternatives attempt to maintain similar pre-existing condition clauses, but open the window for high-risk pools to form as they did before the ACA. Individuals who were unable to qualify for commercial health insurance because of poor health conditions had no other option but to turn to high-risk pool insurers, who usually charged double the cost of those in good health. Some of the insurers would even place a waiting period of up to a year before the individuals with pre-existing health conditions would receive coverage. High-risk pools, in most states, resulted in a net loss the government covered through an increase in taxes.
The current Republican proposal to repeal and replace the ACA, the American Health Care Act (AHCA), maintains the ACA’s protections for pre-existing conditions. At the same time, the AHCA also provides funding for states to create and maintain high-risk pools. This may work if federal and state governments continuously subsidize the pools, in addition to sufficiently regulating the amount insurers can charge for premiums. Otherwise, the cost of providing care for those in the high-risk pools becomes prohibitive for insurers, or patients are unable to pay for the high-premiums insurers then pass along to those receiving coverage.
The American Health Care Act keeps the ACA’s protections for pre-existing conditions; however, other provisions of the AHCA may drive up premium prices.
A survey conducted by Alliance for a Better Utah found that about 800 of those surveyed said they were protected from discrimination over pre-existing conditions. Most people surveyed also said they wanted Trump’s administration to keep those protections in place.
The Affordable Care Act gave protection to around 476,000 Utahns (by conservative estimates) who have pre-existing conditions.